When considering the challenges of raising two girls, changing diapers while on chemotherapy was not one that Morgan Alloway anticipated.
At age 27, Alloway, of Cincinnati, Ohio, was diagnosed with stage IV lung cancer. Her youngest was only a year old at the time.
"It was very hard because I was so tired from the surgery, and I was on [chemotherapy pills]. And it turns out I had the cancer when I was pregnant with my second child, which was scary -- you wonder what effect that has," Alloway says.
Alloway is not alone. Though cancer is often thought of as a disease usually that strikes later in life, new research shows that 18 percent of newly diagnosed cancer patients are parents to one or more minor children. Of these patients, nearly a third of them are caring for children under the age of six.
This means that 2.85 million children in the United States are living with a parent who is battling or has survived cancer.
"That's not consistent with many people's view of cancer – [they] think of it as a disease of older adults, who aren't having these parenting challenges at the same time," says the lead author on the study, Kathryn Weaver of Wake Forest University Baptist Medical Center.
This research fills a longtime gap in the cancer literature, offering the first ever population-wide estimate of how many cancer survivors must also handle the challenges of raising children.
To get the estimated number of cancer patients with kids, Weaver and colleagues analyzed recent data on cancer survivors from the U.S. National Health Interview Survey.
Armed with these statistics, researchers hope to alert health professionals that patients with young children might need extra support.
"We really wanted to bring attention to this unique group of survivors and families who may be experiencing even greater challenges because of their family situation," Weaver says.
The Noble family has especial insight into the hardships of coping with cancer while raising a family – both mother and father have had cancer.
In 2006 Catherine Noble was diagnosed with breast cancer. At the time she had a 2-year-old, a 6-year-old, and an 8-year-old.
"I thought raising children was pretty challenging, but [at the time] I thought, 'Now you're telling me I have to fight for my life?'" she says.
One of the hardest parts for Noble was the Catch-22 of being a parent who's trying to get well.
"In order for me to be a good mom I have to fight this other battle, but that battle will get in the way of me being able to do the things I need to be a good mom. After my mastectomy I couldn't pick up my two-year-old or even carry her."
Noble is now in remission, but in February, her husband Ian was diagnosed with stage IV lung cancer, for which he is currently being treated.
"Now that their dad is going through treatment, we talk about how he might be grumpy and he'll need to sleep a lot more than they're used to. In some ways, me having cancer [allowed] the kids to see that you can get through it and survive. Your hair grows back, you get back to your old self," she says.
Researchers estimated that 562,000 children are living with a parent who is in the early -- and most intense -- phases of cancer treatment.
"Cancer can be a very stressful experience for children in the household," Weaver says, and often, the parent might not even know the extent of the strain that is put on the child. Past research has found that kids often don't speak up and say that they're struggling, trying not to overload or worry their parents, she says.
Even after loved ones go into remission, the fears about cancer can stay with a child.
"My oldest daughter has had the family to talk to about [my cancer throughout the process], but even now she still has questions. She asked me the other day if she was going to get cancer now -- that was really hard for me," Alloway says.
Support groups can be a place for kids to express their feelings about their parents' cancer without fearing that they will burden their families. But while the online community has a thriving support system, there aren't that many in-the-flesh support groups.
"Support groups aren't that easy to find," Alloway says. "I wanted my daughter, my husband, and myself in one, but I didn't find any for people our age in our area."
Having extended family members, friends, and neighbors around to help out with their kids was essential in coping through the treatment stage, say Noble and Alloway.
Currently there are no standards of care guiding oncologists on how to help cancer patients with young children, says Dr. Nathan Pennel, Alloway's doctor and assistant professor of medicine at the Cleveland Clinic.
"There's a saying among oncologists that families get cancer, not just patients. That's especially true with younger patients who have children," he says. "There should be some kind of formal plan, so that doctors know how to advise patients on how to cope with treatment while raising their kids."
"Because cancer is thought of as something that happens to the elderly, this is an underappreciated issue."